Wang J F, Guo J H, Zhu H B, Ye Z S, Shu W Y, Wu J H, Zhou Y A
Department of Urology, Zhejiang Quhua Hospital, Quzhou 324004, China.
Department of Urology, No. 9 People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200011, China.
Zhonghua Wai Ke Za Zhi. 2022 Feb 1;60(2):164-168. doi: 10.3760/cma.j.cn112139-20210302-00104.
To examine the effectiveness and safety of application of the ureteral access sheath in the treatment of middle or lower ureteral calculi in patients with large-volume benign prostatic hyperplasia above grade Ⅲ, which is expected to avoid the simultaneous or staged treatment of benign prostatic hyperplasia via eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia. From April 2018 to December 2020, the clinical data of 27 patients with massive benign prostatic hyperplasia above grade Ⅲ and middle and lower ureteral calculi treated with indwelling ureteral access sheath plus ureteroscopy holmium laser lithotripsy at Department of Urology, Zhejiang Quhua Hospital were retrospectively analyzed and followed up. All the patients were male, aged (69.7±12.8) years (range: 55 to 87 years). Prostate volume measured by transrectal ultrasound was (94.8±16.2) cm (range: 85 to 186 cm). The ureteral access sheath was indwelled in advance, and then the semirigid ureteroscopy was introduced through the working channel of the sheath. Holmium laser lithotripsy was performed, and intraoperative and postoperative complications were recorded. Urinary abdominal plain X-ray or CT urography were performed at 1-and 2-month postopaerative to evaluate the residual stones and clinical efficacy. The ureteral access sheath was placed and holmium laser lithotripsy under a semirigid ureteroscopy was performed successfully in all the 27 patients. In 2 patients, a second session of auxiliary procedure was required due to the large load of preoperative stones and residual stones after surgery, among whom 1 patient received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy plus ureteroscopic lithotripsy. The stone free rate at 1-and 2-month postoperative were 92.6% (25/27) and 100% (27/27), respectively. There were no severe complications such as ureteral avulsion and perforation, perirenal hematoma, septic shock, severe hematuria, urinary retention, iatrogenic ureteral stricture occurred during and after the surgery. The ureteral calculus was wrapped by polyps heavily in 1 patient, he was diagnosed as ureteral stenosis 1 month postoperative, receiving laparoscopic resection of ureteral stricture plus anastomosis 3 months postoperative. In the operations of middle and lower ureteral calculi in patients with large-volume prostatic hyperplasia above grade Ⅲ, the ureteral access sheath can be placed first to effectively eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia, and then semirigid ureteroscopic lithotripsy can be safely performed. It could avoid the treatment of benign prostatic hyperplasia at the same time or by stages.
为探讨输尿管通路鞘在治疗Ⅲ度以上重度良性前列腺增生患者中下段输尿管结石的有效性和安全性，期望通过消除重度前列腺增生导致的输尿管镜操作困难角度和阻力，避免同时或分期治疗良性前列腺增生。回顾性分析并随访2018年4月至2020年12月在浙江衢化医院泌尿外科采用留置输尿管通路鞘联合输尿管镜钬激光碎石术治疗的27例Ⅲ度以上重度良性前列腺增生合并中下段输尿管结石患者的临床资料。所有患者均为男性，年龄（69.7±12.8）岁（范围：55至87岁）。经直肠超声测量前列腺体积为（94.8±16.2）cm³（范围：85至186 cm³）。预先留置输尿管通路鞘，然后通过鞘的工作通道插入半硬性输尿管镜。进行钬激光碎石术，并记录术中及术后并发症。术后1个月和2个月行腹部平片或CT尿路造影评估残余结石及临床疗效。27例患者均成功置入输尿管通路鞘并在半硬性输尿管镜下进行钬激光碎石术。2例患者因术前结石负荷大及术后残留结石需行二期辅助治疗，其中1例行体外冲击波碎石术，1例行体外冲击波碎石术联合输尿管镜碎石术。术后1个月和2个月结石清除率分别为92.6%（25/27）和100%（27/27）。术中及术后未发生输尿管撕脱、穿孔、肾周血肿、感染性休克、严重血尿、尿潴留、医源性输尿管狭窄等严重并发症。1例患者输尿管结石被息肉严重包裹，术后1个月诊断为输尿管狭窄，术后3个月行腹腔镜输尿管狭窄切除术加吻合术。在Ⅲ度以上重度前列腺增生患者中下段输尿管结石手术中，可先置入输尿管通路鞘，有效消除重度前列腺增生导致的输尿管镜操作困难角度和阻力，然后安全地进行半硬性输尿管镜碎石术。可避免同时或分期治疗良性前列腺增生。
